U.S. patent number 7,048,727 [Application Number 10/419,036] was granted by the patent office on 2006-05-23 for continuous feeding and decompressing device and method.
Invention is credited to Gerald Moss.
United States Patent |
7,048,727 |
Moss |
May 23, 2006 |
Continuous feeding and decompressing device and method
Abstract
A decompressing and feeding device for safely feeding in the
gastrointestinal tract of a recovering patient continuously
aspirates and feeds at a rate commensurate with the ability of the
intestines to absorb fluids including nutrient. Air is also
aspirated in the process so that neither air nor excess fluids
cause distension in the gastrointestinal tract. Digestive juices
and nutrients that are aspirated are continuously refed together
with unused feeding material into the gastrointestinal tract at a
location that more efficiently moves and digests the food. The
device may include two aspirate reservoirs to which and from which
aspirate is alternatingly and continuously transferred. To provide
the continuous and alternating flow, a solenoid valve and timer
switch device is provided. Alternatively, a device is provided with
a single aspirate reservoir to which and from which aspirate is
continuously transferred.
Inventors: |
Moss; Gerald (White Plains,
NY) |
Family
ID: |
34992585 |
Appl.
No.: |
10/419,036 |
Filed: |
April 18, 2003 |
Current U.S.
Class: |
604/508; 604/35;
604/93.01; 604/27 |
Current CPC
Class: |
A61J
15/0069 (20130101); A61J 15/0003 (20130101); A61M
31/00 (20130101); A61M 1/75 (20210501); A61J
15/0076 (20150501); A61J 15/0092 (20130101); A61J
15/0096 (20130101); A61M 1/0023 (20130101) |
Current International
Class: |
A61M
31/00 (20060101) |
Field of
Search: |
;604/27,35,410,22,236,30,523,534,535,538,158,159,171,173,176,264,246,276 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Sirmons; Kevin C.
Attorney, Agent or Firm: Schmeiser, Olsen and Watts LLP
Claims
The invention claimed is:
1. A feeding and decompression device for feeding into and
aspirating from an intestinal tract, comprising: a first aspirate
reservoir and a second aspirate reservoir each connected to an
aspiration channel; at least one vacuum source fluidly connected to
the first and the second aspirate reservoirs and adapted to induce
a flow of an aspirate from the aspiration channel to at least one
of the reservoirs; a solenoid valve connected to the first and
second aspirate reservoirs and to the vacuum source; a timer switch
connecting a power source to the solenoid valve; and wherein the
timer switch and solenoid valve alternatingly fluidly connect the
first and second aspirate reservoirs with the vacuum source.
2. The feeding and decompression device of claim 1, wherein the
timer switch and the solenoid valve connect the reservoir that is
not connected to the vacuum source to a vent.
3. The feeding and decompression device of claim 2, wherein the
solenoid valve and switch simultaneously: open a first valve
between the first aspirate reservoir and the vacuum source, close
the first valve between the first aspirate reservoir and the vent,
close a second valve between the second aspirate reservoir and the
vacuum source, and open the second valve between the second
aspirate reservoir and the vent; whereby: aspirate is drawn into
the first reservoir by the lower pressure from the vacuum source;
and aspirate flows out of the second reservoir and into the second
feed line under the influence of gravity.
4. The feeding and decompression device of claim 1, further
comprising: a first overflow chamber connected to the first
reservoir for receiving a first excess volume that exceeds a first
predetermined aspirate volume; and a second overflow chamber
connected to the second reservoir for receiving a second excess
volume that exceeds a second predetermined aspirate volume.
5. The feeding and decompression device of claim 4, wherein the
first reservoir is connected to the solenoid valve by the first
overflow chamber; the second reservoir is connected to the solenoid
valve by the second overflow chamber; and the fluid connection of
the vacuum source to a respective one of the reservoirs is adapted
to draw a respective one of the excess volumes in excess of a
respective one of the predetermined volumes.
6. The feeding and decompression device of claim 5, further
comprising: a first draw tube connecting the first reservoir with
the first overflow chamber; a second draw tube connecting the
second reservoir with the second overflow chamber; and wherein the
first and second draw tubes each have lower ends that are
adjustably supported in the first and second reservoirs to
adjustably provide the first and second predetermined volumes.
7. A feeding and decompression device for feeding into and
aspirating from an intestinal tract, comprising: a first aspirate
reservoir and a second aspirate reservoir each connected to an
aspiration channel; and at least one vacuum source fluidly
connected to the first and the second aspirate reservoirs and
adapted to induce a flow of an aspirate from the aspiration channel
to at least one of the reservoirs; wherein: the first reservoir has
a first combination feeding and aspirating line connected thereto;
the second reservoir has a second combination feeding and
aspirating line connected thereto; the combination feeding and
aspirating lines are adapted to alternatingly guide a feeding fluid
and an aspirate; the first combination feeding and aspirating line
branches into a first feeding line and a first aspirating line; the
second combination feeding and aspirating line branches into a
second feeding line and a second aspirating line; the first and
second aspirating lines join into a common aspiration channel
upstream of the first and second aspirating lines; and the first
and second feeding lines join into a common feeding channel
downstream of the first and second feeding lines.
8. The feeding and decompression device of claim 7, further
comprising: a filter in fluid communication with at least one of
the aspiration channel, the first aspiration line, and the second
aspiration line; and a feeding material line connected to the
feeding channel.
9. A solenoid valve and timer device for alternating valves of the
solenoid and timer device between positions, comprising: a
solenoid; a valve housing having at least four connection points
for connecting a plurality of fluid lines, the valve housing
connected to the solenoid such that the solenoid operatively
controls at least two valves within the housing; an adjustable
timer that meters time for a cycle of a predetermined period of the
time, the adjustable timer being connected to the solenoid; a
switch connected with the timer and alternating between an open and
a closed state for predetermined portions of the cycle; a source of
power connected to the solenoid by a circuit including the switch;
wherein: the switch is alternatingly closed and opened by the
timer, power from the power source is correspondingly applied to
and removed from the solenoid, and the solenoid simultaneously
moves the at least two valves between a first position and a second
position.
10. The solenoid valve and timer device of claim 9, wherein the two
valves are provided by a single motive member.
11. The solenoid valve and timer device of claim 10, wherein the
motive member is a rotary member.
12. The solenoid valve and timer device of claim 10, wherein the
motive member comprises a piston member.
13. The solenoid valve and timer device of claim 10, further
comprising: a microcircuit; and wherein the timer is provided by
the microcircuit.
14. The solenoid valve and timer device of claim 13, wherein at
least a portion of the switch is provided by the microcircuit.
15. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position; placing a distal end of an aspiration
channel at a second position that is spaced proximally relative to
the first position; and continuously aspirating via the aspiration
channel; wherein the step of continuously aspirating further
comprises substantially collapsing a portion of a jejunum at the
second position.
16. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position in the gastrointestinal tract; placing
a distal end of an aspiration channel at a second position in the
gastrointestinal tract that is spaced proximally relative to the
first position; and continuously aspirating via the aspiration
channel; continuously feeding via the feeding channel; feeding from
one of a plurality of aspirate reservoirs into which nothing is
being aspirated; wherein: the steps of continuously aspirating and
continuously feeding further comprise aspirating into at least one
of the plurality of aspirate reservoirs at a time through the
aspiration channel; and the aspiration channel is common to all of
the aspirate reservoirs.
17. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position in the gastrointestinal tract; placing
a distal end of an aspiration channel at a second position in the
gastrointestinal tract that is spaced proximally relative to the
first position; continuously aspirating via the aspiration channel;
and continuously feeding via the feeding channel; wherein the steps
of continuously aspirating and continuously feeding further
comprise alternatingly aspirating into a plurality of aspirate
reservoirs in a repeated cycle.
18. The method of feeding and decompressing of claim 17, further
comprising feeding from one of the plurality of aspirate reservoirs
into which nothing is being aspirated.
19. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position in the gastrointestinal tract; placing
a distal end of an aspiration channel at a second position in the
gastrointestinal tract that is spaced proximally relative to the
first position; continuously aspirating via the aspiration channel;
and continuously feeding via the feeding channel; wherein: the step
of continuously aspirating comprises aspirating into a first
reservoir during a first part of a cycle and aspirating into a
second reservoir during a second part of the cycle; and the step of
continuously feeding comprises feeding from the second reservoir
during the first part of the cycle and feeding from a first
reservoir during a second part of the cycle.
20. The method of feeding and decompressing of claim 19, wherein
the step of continuously aspirating further comprises: aspirating
an amount of aspirate greater than a predetermined maximum into a
first overflow chamber connected to the first reservoir during the
first part of the cycle; and aspirating an amount of aspirate
greater than the predetermined maximum into a second overflow
chamber connected to the second reservoir during the second part of
the cycle.
21. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position; placing a distal end of an aspiration
channel at a second position that is spaced proximally relative to
the first position; continuously aspirating via the aspiration
channel; and continuously feeding via the feeding channel; wherein
the step of continuously feeding further comprises returning at
least a portion of digestive juices and feeding material to the
first position that were previously aspirated at the second
position.
22. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position in the gastrointestinal tract; placing
a distal end of an aspiration channel at a second position in the
gastrointestinal tract that is spaced proximally relative to the
first position; continuously aspirating via the aspiration channel;
continuously feeding via the feeding channel; and inhibiting
distending of the gastrointestinal tract by limiting an amount of
aspirate that is refed into the feeding channel.
23. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position; placing a distal end of an aspiration
channel at a second position that is spaced proximally relative to
the first position; continuously aspirating via the aspiration
channel; continuously feeding via the feeding channel; and
simultaneously: impeding overfeeding, distending, and dehydration;
and obtaining direct feedback regarding absorption of a feeding
material in the gastrointestinal tract.
24. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position; placing a distal end of an aspiration
channel at a second position that is spaced proximally relative to
the first position; continuously aspirating via the aspiration
channel; and continuously feeding via the feeding channel; wherein
the steps of placing, continuously aspirating, and continuously
feeding further comprise improving the efficiency of digestion by
removing gas from a gastrointestinal tract and by stepping a
feeding material forward in the gastrointestinal tract to a
location where greater peristaltic activity facilitates
absorption.
25. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position; placing a distal end of an aspiration
channel at a second position that is spaced proximally relative to
the first position; continuously aspirating via the aspiration
channel; continuously feeding via the feeding channel; and reducing
dehydration by: aspirating digestive juices and feeding material
that are not being readily absorbed in the second position; and
refeeding the digestive juices and the feeding material at the
second position where they are absorbed.
26. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position; placing a distal end of an aspiration
channel at a second position that is spaced proximally relative to
the first position; continuously aspirating via the aspiration
channel; and continuously feeding via the feeding channel; and
maximizing feeding while preventing overfeeding by: observing a
volume of aspirate collected during aspiration; and adjusting the
pressure or the flow resistance in the feeding channel so that the
volume aspirated during a period of time is substantially equal to
or less than the volume absorbed during the same period of
time.
27. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position in the gastrointestinal tract; placing
a distal end of an aspiration channel at a second position in the
gastrointestinal tract that is spaced proximally relative to the
first position; and continuously aspirating via the aspiration
channel; wherein the step of continuously aspirating further
comprises: alternatingly aspirating into at least one of a
plurality of aspirate reservoirs at a time; and aspirating into the
plurality of reservoirs in a repeated cycle.
28. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position in the gastrointestinal tract; placing
a distal end of an aspiration channel at a second position in the
gastrointestinal tract that is spaced proximally relative to the
first position; and continuously aspirating via the aspiration
channel; wherein the step of continuously aspirating further
comprises alternatingly aspirating into a first reservoir and a
second reservoir.
29. A method of feeding and decompressing in a gastrointestinal
tract, comprising the steps of: placing a distal end of a feeding
channel at a first position in the gastrointestinal tract; placing
a distal end of an aspiration channel at a second position in the
gastrointestinal tract that is spaced proximally relative to the
first position; continuously feeding via the feeding channel; and
continuously aspirating via the aspiration channel; wherein the
steps of continuously aspirating and continuously feeding further
comprise alternatingly aspirating into a first reservoir and a
second reservoir.
30. The method of feeding and decompressing of claim 29, further
comprising feeding from one of the plurality of aspirate reservoirs
into which nothing is currently being aspirated.
31. A feeding and decompression device for feeding into and
aspirating from an intestinal tract, comprising: a first aspirate
reservoir and a second aspirate reservoir each connected to an
aspiration channel; at least one vacuum source fluidly connected to
the first and the second aspirate reservoirs and adapted to induce
a flow of an aspirate from the aspiration channel to at least one
of the reservoirs; a valve connected to the first and second
aspirate reservoirs and to the vacuum source; a timer switch
connecting a power source to the valve; and wherein the timer
switch and valve alternatingly fluidly connect the first and second
aspirate reservoirs with the vacuum source.
32. The feeding and decompression device of claim 31, wherein the
timer switch and the valve connect the reservoir that is not
connected to the vacuum source to a vent.
33. The feeding and decompression device of claim 31, wherein: the
timer switch and the valve connect the reservoir that is not
connected to the vacuum source to a vent; the valve and switch
operating to: open a first valve between the first aspirate
reservoir and the vacuum source, close the first valve between the
first aspirate reservoir and the vent, close a second valve between
the second aspirate reservoir and the vacuum source, and open the
second valve between the second aspirate reservoir and the vent;
whereby: aspirate is drawn into the first reservoir by the lower
pressure from the vacuum source; and aspirate flows out of the
second reservoir and into the second feed line under the influence
of gravity.
34. The feeding and decompression device of claim 31, further
comprising at least one overflow chamber connected to the
reservoirs for receiving an excess volume that exceeds a
predetermined aspirate volume, wherein the reservoirs are connected
to the valve by the at least one overflow chamber.
35. The feeding and decompression device of claim 34, further
comprising: at least one draw tube connecting the reservoirs with
the overflow chamber; and wherein the at least one draw tube has a
lower end that is adjustably supported in the reservoirs to
adjustably provide the predetermined volume.
36. The feeding and decompression device of claim 34, wherein: the
at least one overflow chamber is a first overflow chamber connected
to the first reservoir for receiving a first excess volume that
exceeds a first predetermined aspirate volume, wherein the first
reservoir is connected to the valve by the first overflow chamber;
the feeding and decompressing device further comprises a second
overflow chamber connected to the second reservoir for receiving a
second excess volume that exceeds a second predetermined aspirate
volume, wherein the second reservoir is connected to the valve by
the second overflow chamber; and the fluid connection of the vacuum
source to a respective one of the reservoirs is adapted to draw a
respective one of the excess volumes in excess of a respective one
of the predetermined volumes.
37. The feeding and decompression device of claim 34, further
comprising: a first draw tube connecting the first reservoir with
the first overflow chamber; a second draw tube connecting the
second reservoir with the second overflow chamber; and wherein the
first and second draw tubes each have lower ends that are
adjustably supported in the first and second reservoirs to
adjustably provide the first and second predetermined volumes.
38. A feeding and decompression device for feeding into and
aspirating from an intestinal tract, comprising: a first aspirate
reservoir and a second aspirate reservoir each connected to an
aspiration channel that is adapted to be placed in a
gastrointestinal tract; and at least one vacuum source fluidly
connected to the first and the second aspirate reservoirs and
adapted to induce a flow of an aspirate from the aspiration channel
to at least one of the reservoirs; and a valve connected to the
first and second aspirate reservoirs and to the vacuum source, the
valve comprising a motive member movable between a first position
and a second position; the motive member fluidly connecting one of
the aspirate reservoirs to the vacuum source and fluidly closing a
connection of the other of the aspirate reservoirs to the vacuum
source in the first position, and the motive member fluidly
connecting the other of the aspirate reservoirs to the vacuum
source and fluidly closing the connection of the one of the
aspirate reservoirs to the vacuum source in the second
position.
39. A feeding and decompression device for feeding into and
aspirating from an intestinal tract, comprising: a first aspirate
reservoir and a second aspirate reservoir each connected to an
aspiration channel; at least one vacuum source fluidly connected to
the first and the second aspirate reservoirs and adapted to induce
a flow of an aspirate from the aspiration channel to at least one
of the reservoirs; a valve connected to the first and second
aspirate reservoirs and to the vacuum source; a first vacuum
control device in the first reservoir and connected to the valve;
and a second vacuum control device in the second reservoir and
connected to the valve.
40. An actuator and timer device for a gastrointestinal feeding and
decompression apparatus, the actuator and timer device for
alternating valves of the device between positions, the actuator
and timer device comprising: an actuation mechanism; a valve
housing having at least four connection points for connecting a
plurality of fluid lines, the valve housing connected to the
actuation mechanism such that the actuation mechanism operatively
controls at least two valves within the housing; an adjustable
timer that meters time for a cycle of a predetermined period of the
time, the adjustable timer being connected to the actuation
mechanism; a motive source connected to the timer for providing a
predetermined actuation during respective predetermined portions of
the cycle; wherein: the switch is alternatingly closed and opened
by the timer, actuation from the motive source is correspondingly
applied to and removed from the actuation mechanism, and the
actuation mechanism in cooperation with the timer simultaneously
moves the at least two valves between a first position and a second
position.
41. The actuator and timer device of claim 40, wherein the two
valves are provided by a single motive member.
42. The actuator and timer device of claim 41, wherein the motive
member is a rotary member.
43. The actuator and timer device of claim 41, wherein the motive
member comprises a piston member.
44. The actuator and timer device of claim 41, further comprising a
microcircuit, wherein the timer is provided by the
microcircuit.
45. The actuator and timer device of claim 44, wherein at least a
portion of the switch is provided by the microcircuit.
Description
BACKGROUND OF THE INVENTION
1. Technical Field
This invention generally relates to a device used to aspirate a
gastro-intestinal tract and/or to deliver nutrients, fluids,
medication, and/or aspirate into the gastro-intestinal tract. The
invention specifically relates to devices and methods for safely,
efficiently, and continuously aspirating from and feeding into the
gastrointestinal tract.
2. Background Art
Frequently, hospital patients are unable to consume food normally.
In these situations, it is often necessary to use a feeding tube to
provide nutrition, fluids, and/or medicine. Such a tube is inserted
into a patient's gastro-intestinal tract through the nose
(nasogastric or nasoenteric tubes) or surgically by means of a
gastrostomy or jejunostomy. Because adequate nutritional intake
facilitates recovery, the proper use of a feeding tube and an
associated device for feeding through the feeding tube can greatly
benefit a patient.
However, the feeding tubes and the associated devices and methods
also pose some discomfort, and even some potential risks, to
patients. A number of commercially available feeding tubes exist.
Unfortunately, all presently available feeding tube devices and
methods for feeding through the tubes suffer from a variety of
deficiencies. One common problem is that a feeding tube may deliver
the fluids (which include liquid nutrition, hydrating fluids, and
medicine to the patient) at a rate exceeding the ability of the
gastro-intestinal tract to absorb such fluids. This results in an
accumulation of fluid within the intestine. In particularly bad
cases, accumulation of fluid causes distension of the intestine
that leads to the temporary loss of all residual intestinal
function. In rare cases, this intestinal distention may induce
fatal vagal reflex circulatory changes. Approximately 1 in 1000
patients that are fed through a jejunal tube die of bowel necrosis,
a complication that may be related to the lack of safety of the
devices and methods of feeding directly into the gastrointestinal
tract. Severely ill, malnourished patients are most at risk for
developing complications associated with overfeeding. Aside from
being at high risk, these patients are also most in need of the
earliest optimum nutrition. In any case, when a patient's intestine
is not operating fully, then the amount of nutrition the patient
can receive is limited. However, adequate nutrition is obviously a
critical part of anyone's health and is necessary in order to
provide optimum recovery for a patient. It is thus desirable to
deliver as much nutrition to a patient as can be absorbed safely by
the patient's impaired gastro-intestinal tract. Devices and methods
of the past are deficient in providing this maximum feeding in a
safe, prompt, and effective way to patients in need.
It is not desirable to simply deliver a maximum amount of nutrition
into a patient's intestine. The reason for this is that
overfeeding, which is delivering feedings at a rate exceeding the
ability of the patient's gastrointestinal tract to absorb its own
secretions plus the added nutrition, itself presents serious
hazards to a patient. Overfeeding a patient leads to an
accumulation of fluid, which distends the intestine. This
intestinal distension can lead to fatal circulatory changes. More
commonly, complications from overfeeding include the temporary
further impairment of intestinal function, with nausea and
vomiting, which at a minimum causes discomfort and delays recovery.
A common and more severe related complication is impaired ability
to breathe deeply and cough because of abdominal distention,
resulting in atelectasis and pneumonia.
A patient's impaired digestive system may also produce too many
digestive secretions for the patient to reabsorb immediately. A
typical person secretes seven to eight liters of fluid per day,
starting with saliva. All secretions normally are reabsorbed by the
intestine, without net loss or gain of fluid for the body.
Unfortunately, during recovery from surgery the level of secretions
remains relatively constant or decreases, while the intestine's
ability to absorb secretions is typically impaired, sometimes
severely. The result can be a build up of fluid in the intestine,
with the same detrimental side effects as found with over-feeding.
The problem of digestive secretions can be exacerbated by
feeding.
When concentrated nutrition is delivered to a patient's
gastro-intestinal tract, the body's natural response is to produce
digestive secretions to dilute the feedings and break down the
complex nutrients for absorption by the intestine. However, if a
patient's gastro-intestinal function is severely impaired only a
portion of the total fluid may be absorbed. By way of example, for
2 ml of nutrition delivered to the gastro-intestinal tract, 10 ml
of digestive secretions may be provided in response. The intestine
may temporarily be capable of absorbing only 2 ml of fluid,
resulting in a net increase of 10 ml to the volume of fluid in the
gastro-intestinal tract. Thus, nutrition delivered to the intestine
may be competing with digestive secretions for absorption by the
intestine. This problem may worsen as feedings continue, causing
progressive intestinal distension which, in turn, further impairs
intestinal function and reduces the amount of nutrient actually
being absorbed. To avoid problems of overfeeding or excessive
secretion build up during recovery, a patient's gastrointestinal
tract may be aspirated to remove excessive fluid. However, any
secretions removed in this way will cause a net loss of fluids and
dehydration of the patient. Past solutions to this problem include
providing replacement fluids in the form of an intravenous saline
solution. However, this method of fluid replacement does not
conserve nutrients and digestive juices that may have otherwise
been used.
Another problem that has not adequately been solved is that the
very presence of a nasal feeding tube stimulates swallowing by the
patient, introducing additional air into the intestine. The
presence of air within the gastro-intestinal tract interferes with
the propulsion and absorption of nutrition and can be quite
uncomfortable or painful to a patient. The use of an aspirating
tube to remove air from the gastro-intestinal tract has been used
to combat this problem. As set forth above, aspirating introduces
additional problems of increased risks of dehydration and removal
of potentially beneficial nutrients.
Unfortunately, the use of a second tube for aspiration presents new
problems. The introduction of a second tube only adds to the pain
and discomfort experienced by a patient. Furthermore, if a separate
second tube is used, it may be difficult to effectively locate it
proximate to the feeding tube, thereby preventing it from
aspirating excessive food present in the gastro-intestinal
tract.
DISCLOSURE OF THE INVENTION
The present invention overcomes the many deficiencies of the past
and has many advantages as will become apparent in the following
disclosure and description. Accordingly, the invention relates to a
device for providing as much nutrient to the gastro-intestinal
tract as possible without overfeeding, for example, in a patient
recovering from surgery. The invention also includes a device and a
method that improves the efficiency of absorption in the
gastrointestinal tract by removing gas and by stepping a feeding
material forward to a location in which greater peristaltic
activity promotes greater absorption and flow. The device and
method further reduce the tendency to dehydration of past devices
and methods. The present invention incorporates the principles of
the Applicant's prior inventions disclosed in U.S. Pat. No.
6,447,472, filed Oct. 19, 2000, and issued Sep. 10, 2002, the
disclosure of which is incorporated herein by reference. The
present invention has many added features, structural differences,
and utilizes distinct methods. The new aspects safely provide
continuous aspiration and continuous feeding and other advantages
that have not been adequately addressed by devices and methods of
the past.
It is to be explicitly understood that the devices and methods of
the present invention are not limited to use in human patients, but
may be used in veterinarian applications or even in other
non-medical applications. Furthermore, it is to be understood that
while the devices are specifically applicable in the
gastro-intestinal tract of a body, the devices may also be useful
in other organs or systems of the human. Therefore, the disclosure
directed specifically to the application of the devices and methods
for feeding and decompressing in the gastro-intestinal tract is to
be considered exemplary and not restrictive. The limitations of the
devices and methods are to be interpreted in accordance with the
appended claims.
In one aspect, the invention comprises a feeding and decompression
device for feeding into and aspirating from an intestinal tract. In
this aspect, the device includes a first aspirate reservoir and a
second aspirate reservoir each connected to an aspiration channel.
A vacuum source is alternatingly fluidly connected to the first and
the second aspirate reservoirs and induces a flow of an aspirate
from the aspiration channel to at least one of the reservoirs at a
time.
To facilitate the switching between the reservoirs, the device
includes a solenoid valve connected to the first and second
aspirate reservoirs and to the vacuum source. A timer switch
connects a power source to the solenoid valve so that the timer
switch and solenoid valve alternatingly fluidly connect the first
and second aspirate reservoirs with the vacuum source. Furthermore,
the timer switch and the solenoid valve connect the reservoir that
is not connected to the vacuum source to a vent. Specifically, the
first and second reservoirs can be continuously switched back and
forth between being connected to the vacuum source and the vent so
that one reservoir is always connected to the vacuum source and one
is always connected to the vent.
In another aspect of the invention, the device simply comprises a
solenoid valve and timer device for alternating valves of the
device between positions. In this aspect, the device includes a
solenoid and a valve housing having at least four connection points
for connecting a plurality of fluid lines. The valve housing is
connected to the solenoid such that the solenoid operatively
controls at least two valves within the housing. The solenoid and
timer device has an adjustable timer that meters time for a cycle
of a predetermined period of the time. The adjustable timer is
connected to the solenoid and to a switch so that the switch
alternates between an open and a closed state for predetermined
portions of the cycle. This cycle can be repeated indefinitely. A
source of power is connected to the solenoid by a circuit that
includes the switch. Thus, the switch is alternatingly closed and
opened by the timer, whereby power from the power source is
correspondingly applied to and removed from the solenoid. The power
being repeatedly turned on and off causes the solenoid to
simultaneously move the at least two valves between a first
position and a second position.
In this aspect, the power can actuate any number of valves by any
number of members. However, the at least two valves can be provided
by a single motive member. The single motive member can provide a
rotary valve. Alternatively, the motive member can include a piston
member.
The timer can be provided as a mechanical or electromechanical
timer. The timer can be provided by a microcircuit. In this regard,
it is contemplated that at least a portion of the switch can also
be provided by the microcircuit.
In still another aspect, the invention has a feeding and
decompression device providing substantially constant aspiration
during feeding yet does not require a solenoid valve and a timer.
In this aspect, the invention incorporates a single aspirate
reservoir and provides constant aspiration and feeding by a means
other than switching between two or more such reservoirs. In this
aspect, a feeding and decompression device includes at least one
aspirate reservoir having an aspiration port and a feeding port. An
aspiration channel is connected to the aspirate reservoir via the
aspiration port. A feeding channel is connected to the aspirate
reservoir via the feeding port. A vacuum source is connected to the
aspiration channel for drawing aspirate toward the aspirate
reservoir. The vacuum source in this aspect of the invention can be
provided by an electric pump fluidly connected directly to the
aspiration channel.
The invention includes a method of feeding and decompressing. In
particular, the invention includes a method of feeding and
decompressing in a gastro-intestinal tract. The method includes
initial steps of placing a distal end of a feeding channel at a
first position and a distal end of an aspiration channel at a
second position that is spaced proximally relative to the first
position. In accordance with the method, digestive juices and any
nutrient or feeding material therein are continuously aspirated via
the aspiration channel. In accordance with one aspect of the
method, the step of continuously aspirating further comprises
substantially collapsing a portion of the jejunum at the second
position. The method further comprises continuously feeding via the
feeding channel.
In one aspect of the method, the steps of continuously aspirating
and continuously feeding further include aspirating into at least
one of a plurality of aspirate reservoirs at a time through the
aspiration channel. In accordance with the method, the aspiration
channel can be common to all of the aspirate reservoirs.
In another aspect of the method, the step of continuously feeding
includes feeding from one of the plurality of aspirate reservoirs
into which nothing is being aspirated. That is, aspirate can be
directed into other(s) of the plurality of aspirate reservoirs
simultaneously with the step of feeding from the one aspirate
reservoir into the feeding channel. The method further includes
supplying the feeding channel with feeding material from an unused
feeding material line and from at least one refeeding line
connected to another of the aspirate reservoirs.
In still another aspect of the method, the step of continuously
feeding further comprises returning at least a portion of digestive
juices and feeding material to the first position that were
previously aspirated at the second position. This return of
digestive juices reduces the tendency of dehydration in a patient.
The return of the feeding material reduces waste of the material.
However, this refeeding and feeding must be accomplished in a way
that avoids physiological harm and discomfort. Therefore, the
method of feeding and decompressing further includes inhibiting
distending of the gastro-intestinal tract. This is achieved by
limiting an amount of aspirate that is fed and refed into the
feeding channel during a certain period of time. As such, the
method not only includes simultaneously impeding overfeeding,
distending, and dehydration, but also facilitates obtaining direct
feedback regarding absorption of a feeding material in the
gastro-intestinal tract. This feedback can be in the form of
observing a volume of aspirate that is greater than a predetermined
amount. Thus, the method can also include adjusting the pressure or
the flow resistance in the feeding channel so that a volume of
aspirated fluid during a period of time is substantially equal to
or less than the volume absorbed during the same period of
time.
Other advantageous aspects of the method are improving an
efficiency of digestion and absorption by removing gases from a
gastro-intestinal tract and by stepping a feeding material forward
in the gastro-intestinal tract to a location where greater
peristaltic activity facilitates absorption. As can be appreciated,
the efficiency can be improved to a case specific and time
dependent maximum by the steps of observing and adjusting as set
forth above. To this end, the volume of aspirate returned plus the
unused feeding material to be fed can be made to be substantially
equal to the volume absorbed. As long as the sum of the fluid to be
fed is not greater than the fluid being absorbed, overfeeding will
be avoided.
The foregoing and other features and advantages of the present
invention will be apparent from the following more detailed
description of the particular embodiments of the invention, as
illustrated in the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a diagrammatic view of a system including a device
according to a first embodiment of the present invention, depicting
a use for feeding and decompressing in a gastro-intestinal region
of a patient;
FIG. 2 is an enlarged diagrammatic view of the device of the
embodiment shown in FIG. 1;
FIG. 3 is a schematic representation of the solenoid valve and
switch device that is included in the device of FIGS. 1 and 2;
and
FIG. 4 is a diagrammatic view of a device according to a second
embodiment of the invention.
DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION
As discussed above, embodiments of the present invention relate to
devices and methods for feeding and decompressing in a
gastro-intestinal tract. As shown in FIG. 1, an aspirate storing
and refeeding device 10 is used to feed and decompress in a
gastro-intestinal tract 15 of a patient 20. To this end, a
combination feeding and aspirating tube 25 is inserted into the
gastro-intestinal tract 15 through the nose and esophagus. Other
ways of accessing the gastrointestinal tract include inserting the
tube through the abdominal wall directly into the jejunum, or
directly into the stomach and intraluminally to the jejunum. As can
be appreciated from FIG. 1, the combination feeding and aspirating
tube 25 is a double lumen tube and comprises an aspiration channel
30 and a feeding channel 35 for handling flow in opposite
respective directions. Combining these channels 30, 35 into a
single composite tube 25 has the advantage of reducing bulk and
complexity in the inserted portion of the channels 30, 35. The
aspiration channel 30 has a distal end 40 including an opening 45
for aspirating fluids including digestive juices and feeding
material. Additional openings located at spaced intervals
proximally from the distal end 40 along the aspiration channel 30
may be provided. This has the effect of aspirating along a greater
length of the gastrointestinal tract as indicated by the collapsed
region shown in FIG. 1. The feeding channel 35 has a distal end 50
extending distally beyond the distal end 40 of the aspiration
channel 30. The distal end of the feeding channel 35 has an opening
55 for delivering feeding material and other fluids as will be
described below. Preferably, the distal end 50 and the opening 55
of the feeding channel 35 is spaced distally from the distal end 40
and opening 45 of the aspiration channel 30 by approximately 1/2
inch. Depending on the particulars of the cite at which the
channels are placed, the separation of the most distal openings 45,
55 may be in the range from 1/4 inch to 12 inches. In most cases,
the separation of the distal openings 45, 55 of the aspirating and
feeding channels 30, 35 will not exceed approximately 6 inches.
In one embodiment, the device 10 comprises a first aspirate
reservoir 60 and a second aspirate reservoir 65. The reservoirs 60,
65 can be provided in the form of burettes having single lumen
combination feeding and aspirating lines 70, 75 for handling both
aspiration and refeeding of aspirate to and from the reservoirs 60,
65, respectively. The combination feeding and aspirating lines 70,
75 generally handle flow in only one direction at a time, either
toward or away from the reservoirs 60, 65. However, flow in one of
the combination feeding lines is generally in an opposite direction
relative to flow in the other of the combination feeding and
aspirating lines 70, 75. Thus, there is an alternating pattern of
aspirating into the first reservoir 60 for a first half of a cycle
and then aspirating into the second reservoir 65 for a second half
of the cycle. Meanwhile, the second reservoir 65 refeeds aspirate
for the first half of the cycle and the first reservoir 60 refeeds
aspirate for the second half of the cycle. This alternating pattern
can be repeated indefinitely during feeding. It is to be understood
that refeeding need not be continuous during all of the half
cycles. Likewise aspiration flow may cease at any point during each
of the half cycles. Additionally, the cycles need not be divided
into halves. Rather any alternating pattern of time is considered
to be within the scope of the invention.
In order to effectuate the alternating pattern of aspirating and
refeeding, the device 10 includes a system of lines 80, 85, 90, 95,
one-way valves 100, and a solenoid valve 105 for alternatingly
connecting the reservoirs to a vacuum source 107. The one-way
valves 100 permit flow in the lines 80, 85, 90, and 95 only in the
directions indicated by the arrows in FIG. 2. Thus, when the
solenoid valve 105 connects either of the reservoirs 60, 65 with
the vacuum source 107, only flow through the aspirating lines 80
and 90 is induced, which in turn induces flow from the aspiration
channel 30. When the vacuum source 107 is disconnected from one of
the reservoirs 60, 65, the contents of that reservoir are permitted
to flow out through one of the feeding lines 85, 95, preferably
under the influence of gravity. Alternatively, a pump or vacuum
source 107 could be connected to the feeding channel 35 to draw and
refeed the aspirate into the feeding channel 35. A filter 108 can
also be placed in the aspiration channel 30 or between the
aspiration channel 30 and the aspirating lines 80, 90 as shown in
FIG. 2.
As shown, the device 10 is in addition to the feeding system that
is typically used in hospitals. As such, a feeding material is
provided in a feeding bag 110. The feeding bag is connected to the
feeding channel by an unused feeding material line 115. The flow of
the feeding material into the feeding channel 35 is affected by the
capacity of the feeding channel 35, the pressure at which the
feeding material is fed from the feeding bag 110, (such as by a
pump), and the flow rate of the aspirate that is being refed into
the feeding channel 35. These and other factors can be adjusted to
adjust the flow of feeding material into the feeding channel.
Preferably, the flow from the feeding bag 110 can be reduced in
proportion to a flow of aspirate that is refed. Thus, waste of
unused feeding material is avoided. Furthermore, nutrients and
digestive juices that typically have been discarded in the past can
be reintroduced and absorbed with little or no loss of fluids and
nutrients.
The device 10 also enables the aspiration to be applied
continuously. That is, vacuum from the vacuum source can be applied
substantially constantly. Flow of the aspirate may not be constant
or continuous due to a presence or a lack of presence of fluids in
the portion of the gastrointestinal tract being aspirated. However,
continuous and/or constant aspiration has the advantage of
continuously removing gases from the gastrointestinal tract as
there is no interval without suction during which gas may be
propelled by peristalsis distal to the most distal aspiration
orifice. Removing these gases has the advantages set forth above.
Furthermore, removing the gases continuously or constantly has the
advantage of preventing distending of the intestines due to build
up of these gases.
Ideally, when the length of the half cycles are set properly, both
refeeding flow and aspiration flow can be continuous, if not
constant. With more constant and/or continuous flow in the feeding
channel, the fluctuation of flow into the gastro-intestinal tract
is reduced. By providing less fluctuation in the flow into the
intestines, distending can further be prevented. Furthermore,
nutrients and fluids will be more constantly available for
absorption by the intestines.
A predetermined volume of aspirate to be retained in the reservoirs
60, 65 can be selected and set. This volume also affects the "head"
or pressure due to gravitational forces that causes the flow of
aspirate out of the reservoirs 60, 65. Preferably, a maximum
predetermined volume to be retained in each reservoir 60, 65 during
each half cycle is in the range from 10 to 15 cc. This reduces the
chance for overfeeding, for example when the half cycle is kept to
approximately 1/2 minute. Perhaps a maximum adjustable volume could
be as much as 35 cc. Adjustment of the predetermined volume is
achieved by adjusting the depth 120 of a lower end 125 of a first
draw tube 130 in the first aspirate reservoir 60. Similarly, the
maximum volume of aspirate to be retained in the second aspirate
reservoir 65 can be adjusted by adjusting a depth 120 of a lower
end 135 of a similar second draw tube 140.
The draw tubes 130, 140 connect the aspirate reservoirs 60, 65 to
first and second overflow chambers 145, 150. These tubes also
provide fluid communication between an interior of each of the
reservoirs 60, 65 and the solenoid valve 105. Thus, draw tubes 130,
140 connect the aspirate reservoirs to the vacuum source 107 in an
alternating pattern as will be described in further detail below.
The draw tubes 130, 140 act to remove aspirate in excess of the
predetermined maximum volume and draw the excess aspirate into
respective overflow chambers 145, 150. The overflow chambers 145,
150 may have any reasonable volume. Preferably, the volume of each
overflow chamber is in the range from 200 4000 cc, with 1000 cc
being a fairly standard capacity. Once removed, the excess aspirate
can be discarded or refed later when the flow of aspirate from the
aspiration channel 30 has decreased.
The first and second overflow chambers 145, 150 are connected to
the solenoid valve by first and second valve connection lines 155,
160. Thus, the overflow chambers 145, 150 are fluidly connected to
the solenoid valve 105 and to the reservoirs 60, 65 via the draw
tubes 130, 140. The solenoid valve preferably comprises a single
motive member 165 contained within a solenoid housing 170. The
motive member 165 provides at least two (2), two-way valves for
connection between at least four ports 175, 180, 185, and 190.
Preferably, the motive member has first and second channels 195 and
197. The first channel 195 connects the first valve connection line
155 from the first aspirate reservoir 60 to the vacuum source 107
through a vacuum line 200 or to an ambient pressure volume through
a vent hose 205. The second channel of the motive member 165
connects the second valve connection line 160 to the ambient
pressure volume through the vent line 205 or to the vacuum source
107 through the vacuum line 200. In one configuration of the
solenoid valve, the motive member 165 is a rotary member that
rotates under the influence of a solenoid through a range of
approximately ninety degrees to exclusively connect either the
first aspirate reservoir 60 or the second aspirate reservoir 65 to
the vacuum source 107 as shown in FIG. 2. Alternatively stated, the
first channel either connects the first reservoir 60 to the vacuum
line 200 or to the vent line 205. Likewise, the second channel 197
of the motive member 165 either connects the second aspirate
reservoir 65 to the vent line 205 or to the vacuum line. Only one
of the reservoirs 60, 65 is connected to the vacuum source 107 at a
time. The other reservoir is connected to ambient air through the
vent line 205. By way of example and not by way of limitation, this
is efficiently achieved by a single motive member that rotates or
moves linearly between only two operating positions.
The connections to the vacuum source 107 and vent 205 are
alternated back and forth so that one of the aspirate reservoirs
60, 65 is connected to the vacuum source 107 and the other is
connected to the vent at all times. Preferably, this is achieved by
a switch connected to the solenoid valve 105, and wherein the
solenoid valve is in a first position when the switch is closed and
in a second position when the switch is opened. That is, applying
power to the solenoid valve places it in a first position and
removing power from the solenoid valve places it in a second
position indicated by the dashed arrows in FIG. 2. Preferably, the
switch is provided by a timer switch 210 in a circuit connected to
a power source 215 as shown in FIG. 3. The timer switch 210 can be
adjusted to actuate its switch at a predetermined interval
corresponding to a half cycle. Thus, the switch 210 will be turned
on or off after each half cycle and the motive member 165 will be
moved to its first or second position.
The solenoid could be replaced by a different solenoid valve. For
example, the solenoid valve may comprise a piston member and more
than four ports. The solenoid valve can connect the aspirate
reservoirs to respective sources of vacuum and/or to respective
vent lines. Further alternatively, the device could be manually
operated. That is, instead of employing a timer switch, a switch
could be operated by hand. Further alternatively, manually operated
valves could be provided so that a person would be required to
switch the connections to the reservoirs back and forth between
vacuum and vent.
As indicated above, the amount of aspirate received into the
reservoirs 60, 65 optimally is equal to or slightly less than the
amount refed during a half cycle of the device. However, the amount
refed varies during feeding and over the course of recuperation.
Therefore, there will be periods of time during some half cycles
when the aspiration is being applied, but little or no aspirate is
flowing. Likewise there will be periods when the aspirate being
refed is completely withdrawn from a reservoir before a current
half cycle has ended. Since a reservoir is connected to ambient
during feeding from that reservoir, there is a potential for
drawing air from the ambient into the feeding channel and
eventually into the gastrointestinal tract. To prevent this from
happening, a check valve is provided in each reservoir 60, 65 by a
ball 220. As shown, the ball 220 is buoyant and is thus positioned
by the aspirate at a first level 225. When the aspirate reaches a
maximum level, the ball floats at the maximum aspirate level as
indicated at 230. However, when the aspirate completely leaves the
reservoirs 60, 65, the ball 220 seats in a sealed position as shown
at 235. With aspirate refeed being induced by gravity, this type of
check valve will normally be sufficient to prevent air from being
drawn into the feeding channel 35. On the other hand, if a positive
pressure pump is employed to draw and refeed the aspirate, a more
positive shutoff valve may be necessary.
As can be appreciated, the device 10 includes solenoid valve and
timer device 240 as shown in FIG. 3. Furthermore, the solenoid
valve and timer device 240 has special characteristics that are
particularly beneficial when used with the overall device 10
described above. Specifically, the solenoid valve 105 could be made
automatic by an electrical circuit including a timer switch 210.
The timer switch can comprise microcircuitry that includes a timer.
The timer switch 210 can further include low voltage switch
actuation that opens and closes the circuit connected to the power
source 215. Alternatively, the timer switch can be made up of
discrete electrical components that accomplish the same alternating
timing function. Further alternatively, the timer switch can
include a combination of electrical and mechanical elements that
achieve the same alternating timing function.
FIG. 4 is a diagrammatic view of a device 245 according to a second
embodiment of the invention. This device 245 differs from the
device 10 described above in that the previously described device
had two aspirate reservoirs whereas the device 245 has only one
aspirate reservoir 250. The aspirate reservoir 250 in this case has
a capacity equal to a maximum volume of aspirate to be retained in
the reservoir. Any excess aspirate will spill into an overflow
chamber 255. A further difference is that the line connected to the
reservoir 250 for refeeding aspirate does not also function to
conduct aspirate to the reservoir 250. That is, the aspirate
channel 30 is connected to the reservoir by an aspirating line 260
and the feeding channel 35 is connected to the reservoir 250 by an
aspirate refeeding line 265. As such, aspiration and refeeding can
occur simultaneously from the same reservoir 245. However,
aspiration cannot be effectuated by a vacuum source in fluid
communication with the aspiration channel via the reservoir 245. If
so, refeeding in the refeeding line 265 would be impeded.
Therefore, a positive pressure pump 270 is provided in the
aspirating line to draw aspirate toward the reservoir 245. Aspirate
can be refed by a gravitational force. However, a pressure source
such as a pump could be substituted. To assure flow in the right
direction, a one way valve 275 is also placed in the aspirating
line 260. As in the previous embodiment a filter 280 is also
preferably placed in the aspirating line 260, or between the
aspirating line 260 and the aspiration channel 30. A check valve
including a ball 220 like that described in the embodiment above is
provided in the reservoir 250 of the device 245. This check valve
functions substantially the same as that described above.
Typically, the reservoir is open to the ambient air so that
aspirate can be refed by gravity. Like the previous embodiment, the
device is intended to be used in addition to a supply of an unused
feeding material that can be fed from a feeding bag 285 by a pump
or gravity.
The device is similar to the previously described embodiment in
that it advantageously provides for continuous or constant
aspiration and refeeding of aspirate. While the device 245 requires
a positive pressure source 270, device 245 does not require the
solenoid and timer device 240 of the previously described
embodiment of FIGS. 1 3.
It is to be understood that the term positive pressure source
generally refers to a pump or an equivalent, such as a syringe or
pressurized receptacle. The term "positive" refers to an "active"
as opposed to a passive pressure means, such as a gravitational
pressure means. It is also to be understood that vacuum source
refers to any number of equivalents such as a pump, an aspirating
syringe, or a negative pressure receptacle. One common vacuum
source is that typically provided by a hospital or other facility
and piped throughout the facility to the various stations including
patients' rooms.
The embodiments and examples set forth herein were presented in
order to best explain the present invention and its practical
application and to thereby enable those of ordinary skill in the
art to make and use the invention. However, those of ordinary skill
in the art will recognize that the foregoing description and
examples have been presented for the purposes of illustration and
example only. The description as set forth is not intended to be
exhaustive or to limit the invention to the precise form disclosed.
Many modifications and variations are possible in light of the
teachings above without departing from the spirit and scope of the
forthcoming claims.
* * * * *